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Get O Classification (required): D Individual/sole Proprietor

Name (as shown on your income tax return) N Business name/disregarded entity name. if different from above Q) r--------------------------------------------------------------------------------------------r------------o, Check appropriate box for federal tax c o classification (required): D Individual/sole proprietor D C Corporation D S Corporation D Partnership D Trust/estate .. .. . .. . Q) 1:1.0 () oi! f .5 D D Exempt Limited liability company. Enter the tax class.

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